January 1996 AAOS Report

HCFA to change X-ray payment policy

Orthopaedic surgeons and other physicians will soon be able to bill Medicare for their interpretation of X-rays taken in hospital emergency departments. The Health Care Financing Administration (HCFA) has changed its payment policy to allow non-radiologists to bill separately for interpretation of X-rays taken in the emergency room when this service "directly contributes to the diagnosis and treatment of the individual patient." Currently, Medicare will only reimburse a hospital radiologist for reinterpretation of an X-ray previously taken by another physician. The new policy will allow only one payment for the interpretation, but would not restrict that payment to radiologists. In order to bill for the interpretation, physicians will be required to submit a separate, dictated report of the interpretation for inclusion in the patient's medical record. The Academy and other specialty societies had previously argued to HCFA that orthopaedists and other physicians who provide emergency room services are well qualified, by virtue of their training, to provide an immediate and accurate interpretation of X-rays. In 1993, the Department of Health and Human Services Inspector General also recommended a change in the payment policy, citing several studies which showed that reinterpretation of X-rays by a radiologist almost never affects the course of patient care. The new payment policy goes into effect Jan. 1.

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